Pathway to Safer Opioid Use - Paper Example

In the first instance, James Parker, the patient who is at a very tough phase of his life due to chronic back pain makes bad decisions regarding the treatment of his condition. He is a part-time mechanic and coach, and a full-time cop and dad. Parker is undergoing serious problems due to chronic pain. He does not have good sleep most nights. He has also lost his social life and his job due to his condition. Chronic pain makes its patients hopeless and frustrated because it is not treatable at once; its treatment is a process that does not even result in a complete overhaul of the pain.

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In the simulation video, Parker visits his primary care physician Dr. Jennings who does not give him enough audience to enable them to make informed decisions about the treatment approach of the patient. The doctor asks him to rate his pain on a scale of 1-10. Parker says it is a 20, meaning that his pain could be extreme. Dr. Jennings insists on the 1-10 scale and finally puts his pain at 9. The doctor prescribes opioids and antidepressants for the patient's condition which upsets Parker. The doctor does not have a thorough doctor-to-patient talk which makes him prescribe the drugs without looking for more suitable alternatives yet opioid use may cause addiction. The usage of these drugs for for severe discomfort or terminal pain is fine and allowed. Their role in the long-term treatment of chronic non-cancer pain is, however, controversial for many reasons, one main explanations is the known effects of psychological dependence that can happen when these of these medicines are used. (Benjamin et al., 2018).

Parker asks to be given more pills which Dr. Jennings declines. Parker clearly wants to have more thorough engagements with the doctor but due to the poor doctor-patient relationship, this is not possible. The patient leaves the hospital more devastated than when he came in.

Parker heads straight to the Pharmacist to buy the prescribed pills. The Pharmacist, Dr. Lee, gives him the pills and asks if he has any questions. Parker says he does not have any questions. He does not even ask about the dosage for the drugs. As a result, he mixes sleeping pills with pain pills, something that could cause his death.

Parker listens to his wife's request for visiting her doctor, Dr. Bright, for help. Both Dr. Bright and Rhonda (the nurse) makes Parker have a whole new perspective about his treatment. At least now he has hope. Parker is asked to take a urine sample for testing. He asks why it is necessary and gets a comprehensive explanation from the nurse.

Dr. Bright makes a good doctor-patient relationship with the engagement of the patient in the decision-making process of the choice of treatment to be considered. Parker decides to bring his wife along with him in his next appointment with Tom, the nurse practitioner, just as the doctor had asked him. Asked if how he would like to address the depression he might be having; Parker decides to start taking medication. Dr. Bright joins in later and gives Parker his prescription of drugs. He makes Parker understand better how to handle the pain and how to take the dosage because he uses the teach-back method or the "show-me" approach to teach him. After this appointment, Parker felt better at most times. However, at certain times, he felt helpless again and the feelings of being in isolation during the sleepless nights made him depressed. This brought about many consequences. He even hurt his eye at one point, became hopeless again and did not actively engage the medics in asking and answering questions during his appointments. As a result of the depression, he ended up overdosing, making him unconscious and almost dying in the process. This year, the Centers for Disease Control and Prevention (CDC) reported a 200% increase in opioid overdose deaths between 2000 and 2014 in the United States. (Sarkar &Shojania, 2017).

In the second instance, Parker visits his primary care physician, Dr. Jennings who does not take his condition seriously. He asks him to rate his pain on a 1-10 scale. Parker says he does not want to sign it a number. The doctor insists his pain is at 9 on the scale without engaging him further. He does not have quality time with the patient in order to forge the doctor-patient relationship between them. The doctor prescribes opioids and sleeping pills for Parker. Parker informs Dr. Jennings that he wants a shared decision-making approach with the doctor who does not do anything to help on this, despite Parker's genuine concern. Parker leaves the hospital in the the worst shape than when he came in.

Parker goes to the pharmacist, Dr. Lee, to buy the prescribed pills. Dr. Lee gives him the drugs and asks if he has any questions. Parker asks her questions about the risks of reactions with the other medication he is on. He gets clarification on the use of the drugs. However, he is still not happy with having to take anti-anxiety drugs. He complains to his wife who refers him to a new doctor, Dr. Bright.

Packer decides to visit the doctor his wife is telling him about. Rhonda, the nurse in the new doctor's hospital, is more welcoming and makes him have hope with his treatment once again. She asks him to take a urine samples for testing and Parker asks why it is necessary because he cannot help but think that they could be suspecting he abuses the opioid pills. He gets a comprehensive explanation from the nurse who informs him that urine sample testing is a standard procedure done on everyone undergoing that kind of treatment.

Dr. Bright joins them later. He is more engaging and gives Parker room to ask questions and involves him in the decision-making process. As a result, Parker gets more hope for a better future. He becomes more active and determined to beat the pain. Dr. Bright even asked him to keep a daily pain log and to ask his wife to join him in the next appointment. Parker did both of these.

Parker takes his wife along with him to his next appointment with Tom, a nurse practitioner directed by Dr. Bright to attend to him. Tom engages them on the numerous approaches to treating chronic pain because chronic pain patients should be treated using a biopsychosocial approach that uses multiple modalities. Parker does not fully support the idea of taking antidepressants like Tom is suggesting. However, due to the thorough engagement and explanations they had with Tom, Parker decides to start taking medication as well as seeing a psychologist. Dr. Bright comes later after this and gives them instructions on how to use the prescribed drugs.

Parker's life becomes better with this set of decisions he makes. He can comfortably carry out some house chores and even have good sleep at night, thanks to the drugs prescribed by Dr. Bright. Parker meets his psychologist who helps him with his mental stability and resilience to keep fighting the pain disorder. The new techniques taught by the psychologist help Parker on days when everything else is not working. In addition to all these factors, Parker's wife is always there for him and he asks for her help whenever he needs it.

In the first instance, James became addicted due to the feelings of emptiness, depression, and hopelessness that were consuming him and were not addressed by the caregivers. The caregivers are partly to blame for his addiction. They do not engage the patient in a genuine doctor-patient conversation by asking his opinions on the kind of medication he prefers to have. This creates a bad doctor-patient relationship, something that is not positive for such disorders. As a result, the patient ends up making poor decisions because he does not even approve of the kind of medication prescribed to him in the first place.

In the second instance, James made very good decisions. For instance, he chooses to take the medication as well as visit the psychologist rather than relying on one treatment option alone. This backs the idea that a biopsychosocial approach that uses multiple modalities is better at treating chronic pain. When he hurt his eye and went to the hospital for treatment, he asked questions that were promptly answered by the caregivers. As a result, he made the right choices whenever he got depressed, exhausted or when his back and eye hurt. He could therefore successfully manage the chronic pain. He was even able to watch his daughter's game, something he could not do before due to the severe pain he used to experience.

References

Benjamin, R., Trescot, AM., Datta, S., Buenaventura, R., Adlaka, R., Sehgal, N., ...& Vallejo, R.,2018. Opioid complications and side effects. Retrieved on May 4, 2019, from

https://www.ncbi.nlm.nih.gov/pubmed/18443635.

Sarkar, U. & Shojania, K., 2017. Patient safety and opioid medications. Retrieved on May 4, 2019, from

http://www.ahrq.gov/.